Although numerous research studies have been devoted to hearing aid selection in adults, only modest research effort has been extended to the study of reliable hearing aid selection procedures with children. Appropriate amplification for children is critical, however, because of the important contribution of auditory information to their speech and language development. Because of the difficulties in obtaining reliable auditory information on hearing-impaired children, current techniques used for hearing aid selection depend largely on threshold measurements, speech recognition scores when permissible, or prescriptive procedures. The objective of this project is to investigate whether adaptive strategies utilizing a paired-comparison technique can be modified for use with children in order to enhance hearing aid selection with this population. Three experiments are proposed to investigate the effects of maturation and degree of hearing loss on children's ability to perform the adaptive procedure reliably, and to compare children's preference judgments of frequency-gain response (determined from the adaptive procedure) with response characteristics predicted by select hearing aid prescriptions. In the first experiment, 30 normal-hearing children between the ages of 5 and 8 years will be tested using the adaptive strategy to select a preferred frequency-gain response that varies in the low and high frequencies by 6 dB steps. The adaptive strategy will be implemented on a master hearing aid that is under computer control. Results obtained with normal-hearing children will be used to target an age range to select hearing-impaired children for the next experiment. In Experiment 2, 30 hearing-impaired children with moderate to severe sensorineural hearing loss (41 to 90 dB HL, re: ANSI S3.6-1989) will be tested on the adaptive procedure, and the frequency-gain responses selected will be compared with responses predicted from two commonly used hearing aid prescriptions. Analyses will be performed to isolate features that underlie children's preference judgments. The purpose of the third experiment is to validate results obtained from the adaptive procedure, and to monitor acclimatization effects that may occur over a period of time. Ten hearing-impaired children will be fitted with programmable hearing aids adjusted to the frequency-gain response selected from the adaptive procedure and verified with probe-tube microphone measurement techniques. Children's progress will be monitored over a 12-week period via measures of phoneme, word, and sentence identification, and by parent and teacher ratings. It is hypothesized that reliable subjective responses obtained from the adaptive procedure in combination with powerful new objective techniques available with real-ear probe-tube microphone systems will lead to a more comprehensive and insightful methodology for individualized selection of hearing aids for children.
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